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PE .MIT APPLiCe�TIC _ � �' —` � `°(' <br /> CITY OF EVERETT PERMIT �ERVICES � <br /> 3200 CEDAR STREET, EVEP.ETT. WH 9R201 <br /> 425-257-881 C - FAX 425-257-8857 -www.everettv�a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CRED:T CARDS ARE NOT ACCEPTED <br /> � SITE ADDRESS ,Z PARCEL TRJ( I.D.# PERMIT:f I <br /> ,��2� s F �i ,��� �� ' ' l� os/8 003 009 ao � c<c, � - c., �? <br /> �E6A LOT NO. BLOCK TRACT � <br /> U�SC. <br /> O!'JMER ADDRESS CITY/ZIP PHONE �G�s� ' <br /> 1_0� u�-itii3 0 � <br /> _�+�alt��" �t '�� �- /< S Vi 1� 7312 � �ak�rS�o�v `D✓ � Lchc 57��•�n••t G/� ' <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �C.N+�y TO�.�,['o... 2zV—Y�( 9-I S�j G <br /> CONTRACTOR AUURESS CITY2IP PHONE <br /> �c �i..�.�S �,ri.. S-r<r c�.-J� IS�i � �iz?�S?_ SF .3 .(vto.�,1� WR �zd-9`lY-t3Y6 <br /> rONTR. LICEN�E# <br /> Ce ,v�yS G213N } <br /> USE OF BUILDING HEAT SOURCE SCONTI�ACT PRICE OF WORK <br /> S: �5 /C Ftviri / C� crt d I <br /> �Glectric �Gas_Other `r" 6 5'"/� �os o oa <br /> _Q�.�srd�.oyTi cJ �O O_ i <br /> WORK DESCRIPTION 'I <br /> ,.;J,l�,C-C� /`J4 � � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OE FIXTURE OR ITEM � NO. TYPE OF FIXTURE OR ITEM '� <br /> � Toilet A/C-air handling unils � <br /> i Bathtub Forced air systems i <br /> � Lavatory(washbasin) � yyaterlheater E'/e �au�c( F/�f � II9 <br /> / Shower <br /> � K�tchen sink 8 disposal � Gas(ireplace <br /> i Dishtvas�ier � Gas range <br /> / Clothes washer ✓ Clothes dryer I <br /> _ Laundry tray ✓ Range hood I <br /> Sink (service/badmop/elc.) v Exhaust fan <br /> / Backflow preventer Heat pump I <br /> Urinel V Unit heater o �+'-� }�! � 6"''� 6 oa�`� <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> i _L Roof drains = Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceriGfy that I have read and examined lhis application and kncw the same to be true and correcL All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or nol The granting of a permil does not presume <br /> to give authority to violate or cancel lhe provision of any other state or local law regulating consWctlon or lhe performance o` �� <br /> cunstruction.That I am authorized by the owner of this property lo perform the work for which application is made and I compty with the - <br /> State Contractors Law 1827 RCW and 296.200 WAC. <br /> � r/�Q�-�-- l� �v�,/ 6/7FD� <br /> SignaWre o OwnedG �ctor/Authonzed Agent Date <br /> ��Z <br />